O câncer colorretal (CCR) pode ocorrer em qualquer parte do cólon ou do reto e representa o terceiro câncer mais comum no mundo em ambos os sexos. As células Natural Killer (NK) fazem parte do sistema imune inato reconhecendo moléculas de HLA de classe I em células alvo, através de seus receptores de membrana killer cell immunoglobulin-like receptors (KIR). O objetivo deste estudo foi avaliar a associação entre os genes KIR e os ligantes HLA em pacientes com câncer colorretal e controles saudáveis. Examinamos o polimorfismo de 16 genes KIR e seus ligantes HLA em 154 pacientes caucasóides com CCR e 216 controles saudáveis pela técnica de PCR-SSO e PCR-SSP. Quando comparamos os dois grupos, não foram encontradas diferenças significativas para os ligantes HLA e os genes KIR após correção de Bonferroni. Entretanto, o grupo de genótipos Bx (heterozigoto e homozigoto para o haplótipo B) foi mais frequente nos controles, quando comparados com os pacientes. Estes achados sugerem que altos níveis de ativação de sinais KIR aparecem como proteção para o câncer colorretal. / Colorectal cancer (CRC) can occur anywhere in the colon or rectum and represents the third most common cancer in the world in both sexes. Natural killer cells (NK) are part of the innate immune system recognizing class I HLA molecules on target cells through their membrane receptors, called killer cell immunoglobulin-like receptors (KIR). The aim of our study was to evaluate the association between the KIR genes and HLA ligands in patients with colorectal cancer and healthy controls. We examined the polymorphism of 16 KIR genes and their HLA ligands in 154 caucasoid CRC patients and 216 healthy controls by PCR-SSO and PCR-SSP. When both groups were compared, no significant differences were found for HLA ligands and KIR genes after Bonferroni correction. However, the Bx group genotypes (heterozygous and homozygous for the haplotype B) were more frequent in controls, when compared with patients. These findings suggest that individuals with Bx genotypes could have some protection to colorectal cancer. These findings suggest that higher levels of activating KIR signals appear as protective to colorectal cancer.

OBJETIVO: Determinar o impacto de fatores prognósticos na sobrevida de pacientes com metástases hepáticas ressecadas e originadas de câncer colorretal. CASUISTICA E MÉTODOS: Foram analisados os prontuários de 28 pacientes submetidos a ressecção hepática de metástases de câncer colorretal de Abril /1992 a Setembro /2001. Foram realizadas 38 ressecções (8 pacientes com mais de uma ressecção no mesmo tempo cirúrgico e 2 pacientes submetidos a re-ressecções). Todos haviam sido submetidos previamente à ressecção do tumor primário. Utilizou-se um protocolo de rastreamento de metástases hepáticas que incluiu revisões clinicas trimestrais, ecografia abdominal e dosagem de CEA até completarem-se 5 anos de seguimento e, após, semestralmente. Os fatores prognósticos estudados foram: estágio do tumor primário, tamanho das metástases > 5cm, intervalo entre ressecção do tumor primário e surgimento da metástase <1 ano, CEA>100ng/ml, margens cirúrgicas <1cm e doença metastática extra-hepática. O estudo foi retrospectivo e a análise estatística foi feita através da curva de Kaplan-Meier, do log rank e da regressão de Cox. RESULTADOS: A morbidade foi 39,3% e a mortalidade operatória foi 3,6%.A sobrevida em 5 anos foi de 35%. Os fatores prognósticos independentes adversos foram: intervalo <1 ano entre ressecção do tumor primário e surgimento da metástase (p=0,047 e RR 11,56) e doença metastática extra-hepática (p=0,004 e RR=57,28). CONCLUSÕES: A ressecção hepática de metástases de câncer colorretal é um procedimento seguro com sobrevida em 5 anos acima dos 30%. Foram fatores prognósticos independentes adversos: doença metastática extra-hepática e intervalo<1ano entre ressecção do tumor primário e surgimento da metástase. / Prognostic factors following liver resection for hepatic metastases from colorectal cancer. BACKGROUND: To determine the impact of prognostic factors on survival of patients with metastases from colorectal cancer that underwent liver resection. METHODS: The records of 28 patients that underwent liver resection for metastases from colorectal cancer between April /1992 and September/2001 were retrospectively analized. Thirty-eight resections were performed (more than one resection in eight patients and two patients underwent re-resections). The primary tumor was resected in all the patients. A screening protocol for liver metastases including clinical examinations every three months, abdominal ultrassonography and CEA level until five years of follow-up and after every six months, was applied. The prognostic factors analized regarding the impact on survival were: Dukes C stage of primary tumor, size of metastasis > 5cm, a disease-free interval from primary tumor to metastasis < 1 year, CEA level > 100ng/ml, resection margins < 1cm and extrahepatic disease. The Kaplan-Meier curves, log rank and Cox regression were used for the statistical analysis. RESULTS: Perioperative morbidity and mortality were 39,3% and 3,6% respectively. The 5-year survival rate was 35%. The independent prognostic factors were: disease-free interval from primary tumor to metastasis < 1year (p=0,047; RR=11,56) and extrahepatic metastatic disease (p=0,004; RR=57,28). CONCLUSIONS: The liver resection for metastases from colorectal cancer is a safe procedure with more than 30% 5-year survival .Disease- free interval from primary tumor to metastasis < 1year and extrahepatic disease were independent prognostic factors.

Stem cells and cancer are inextricably linked and many tumours, including colorectal cancers, contain a small population of self-renewing cells, referred to as cancer stem cells (CSCs), able to give rise to proliferating but progressively differentiating cells that contribute to the cellular heterogeneity typical of solid tumours. Thus, the identification of CSCs and the factors that regulate their behaviour should have a profound impact on cancer treatment. Notch signalling controls the maintenance and differentiation of stem cells in several tissues, including the intestine, where it is essential for stem cells maintenance. Based on these premises, my work was aimed at identifying and characterising the cells that express the Notch1 receptor in intestinal tumours in vivo, with the objective of getting insights into the cellular hierarchy of colon cancer cells. We found that the Notch1 receptor is expressed in rare undifferentiated tumour cells that present self-renewal and multipotency in vivo, as they indefinitely give rise to marked differentiated tumour cells and fuel tumour growth. Our analysis on the transcriptomic profile of these cells confirmed our in vivo observations that Notch1+ tumour cells represent a specific population of highly proliferative tumour cells, expressing several, but not all, known markers of normal intestinal stem cells (ISCs). Indeed, their transcriptional signature highly correlates with normal ISCs. Given that the tumour cells we characterised appear not to carry Apc mutations, we hypothesise that during the earlies steps of tumourigenesis, normal Notch1+ ISCs are engulfed within the nascent tumour (in aberrant hyperproliferative crypts) and are able to grow and expand within this new ecosystem, as they are supported by extrinsic secreted growth factors from the neighbouring mutant cells. The concept that normal ISCs might contribute to tumour expansion highlights the complications that patients can encounter during treatment, since these cells share many features with their wild-type counterparts, making therapy deleterious to normal ISCs. / Les cellules souches et le cancer sont inextricablement liés et de nombreuses tumeurs, y compris les cancers colorectaux, contiennent une petite population de cellules auto-renouvelables, appelées cellules souches cancéreuses (CSCs), capables de donner naissance à des cellules proliférantes mais progressivement différenciatrices qui contribuent à l'hétérogénéité cellulaire typique des tumeurs solides. Ainsi, l'identification des CSC et des facteurs qui régissent leur comportement devrait avoir un impact profond sur le traitement du cancer. Notch signale le contrôle le maintien et la différenciation des cellules souches dans plusieurs tissus, y compris l'intestin, où elles sont essentielles au maintien des cellules souches. Sur la base de ces prémisses, mes travaux visaient à identifier et caractériser les cellules qui expriment le récepteur Notch1 dans les tumeurs intestinales in vivo, dans le but de mieux comprendre la hiérarchie cellulaire des cellules cancéreuses du colon. Nous avons constaté que le récepteur Notch1 s'exprime dans de rares cellules tumorales indifférenciées qui se renouvellent et se multiplient in vivo, car elles donnent lieu indéfiniment à une différenciation marquée des cellules tumorales et à une croissance tumorale. Notre analyse du profil transcriptomique de ces cellules a confirmé nos observations in vivo selon lesquelles les cellules tumorales Notch1+ représentent une population spécifique de cellules tumorales hautement prolifératives, exprimant plusieurs marqueurs connus, mais pas tous, des cellules souches intestinales normales (CSI). En effet, leur signature transcriptionnelle est fortement corrélée avec les CSI normaux. Étant donné que les cellules tumorales que nous avons caractérisées ne semblent pas être porteuses de mutations Apc, nous supposons que durant les premières étapes de la tumorigénèse, les CSI normales Notch1+ sont englouties dans la tumeur naissante (dans des cryptes hyperprolifératives aberrantes) et sont capables de croître et de s'étendre dans ce nouvel écosystème, car elles sont soutenues par les facteurs de croissance extrinsèques des cellules mutantes voisines. Le concept selon lequel les CSI normaux pourraient contribuer à l'expansion tumorale met en évidence les complications que les patients peuvent rencontrer pendant le traitement, puisque ces cellules partagent de nombreuses caractéristiques avec leurs homologues de type sauvage, ce qui rend le traitement délétère pour les CSI normaux.

O câncer colorretal (CCR) pode ocorrer em qualquer parte do cólon ou do reto e representa o terceiro câncer mais comum no mundo em ambos os sexos. As células Natural Killer (NK) fazem parte do sistema imune inato reconhecendo moléculas de HLA de classe I em células alvo, através de seus receptores de membrana killer cell immunoglobulin-like receptors (KIR). O objetivo deste estudo foi avaliar a associação entre os genes KIR e os ligantes HLA em pacientes com câncer colorretal e controles saudáveis. Examinamos o polimorfismo de 16 genes KIR e seus ligantes HLA em 154 pacientes caucasóides com CCR e 216 controles saudáveis pela técnica de PCR-SSO e PCR-SSP. Quando comparamos os dois grupos, não foram encontradas diferenças significativas para os ligantes HLA e os genes KIR após correção de Bonferroni. Entretanto, o grupo de genótipos Bx (heterozigoto e homozigoto para o haplótipo B) foi mais frequente nos controles, quando comparados com os pacientes. Estes achados sugerem que altos níveis de ativação de sinais KIR aparecem como proteção para o câncer colorretal. / Colorectal cancer (CRC) can occur anywhere in the colon or rectum and represents the third most common cancer in the world in both sexes. Natural killer cells (NK) are part of the innate immune system recognizing class I HLA molecules on target cells through their membrane receptors, called killer cell immunoglobulin-like receptors (KIR). The aim of our study was to evaluate the association between the KIR genes and HLA ligands in patients with colorectal cancer and healthy controls. We examined the polymorphism of 16 KIR genes and their HLA ligands in 154 caucasoid CRC patients and 216 healthy controls by PCR-SSO and PCR-SSP. When both groups were compared, no significant differences were found for HLA ligands and KIR genes after Bonferroni correction. However, the Bx group genotypes (heterozygous and homozygous for the haplotype B) were more frequent in controls, when compared with patients. These findings suggest that individuals with Bx genotypes could have some protection to colorectal cancer. These findings suggest that higher levels of activating KIR signals appear as protective to colorectal cancer.

Les cancers gastro-intestinaux, en particulier les cancers colorectaux (CCR) et les cancers gastriques (CG), sont des pathologies agressives avec des taux de mortalité élevés dans le monde. Ces cancers sont caractérisés par la dérégulation de voies de signalisation cellulaire telles que les voies Wnt, Notch et Hippo qui jouent un rôle très important dans la tumorigenèse gastro-intestinale. L’activité des différents facteurs de transcription impliqués dans ces voies de signalisation nucléaire est contrôlée par de nombreux corégulateurs transcriptionnels. Ces travaux de thèse ont porté sur deux corégulateurs transcriptionnels initialement identifiés comme des partenaires des récepteurs nucléaires, à savoir RIP140 et LCoR. L’objectif a été d’explorer l’expression de ces deux facteurs de transcription dans les cancers gastro-intestinaux ainsi que leur rôle dans les cancers gastriques principalement au travers du dialogue avec la voie de signalisation Hippo. L’analyse par immunohistochimie de l'expression de RIP140 et LCoR dans les cancers colorectaux et gastriques a montré que les niveaux d’expression de ces deux corégulateurs transcriptionnels sont fortement corrélés. Dans les CCRs, leur expression tend à diminuer dans le tissu tumoral par rapport au tissu normal adjacent, alors que dans les CGs, les niveaux d’expression de RIP140 et LCoR sont significativement plus élevés dans la tumeur que dans l’épithélium sain. Des corrélations significatives ont été observées avec les paramètres clinicopathologiques des patients (stade TNM et différenciation tumorale) ainsi qu’avec d’autres protéines clés impliquées dans la progression et l'invasion tumorale (incluant E-cadhérine et Cox-2). L'analyse de la survie a montré que les patients atteints de CCR avec des tumeurs LCoRlow/RIP140high ont une durée de survie plus longue. Dans le CG, l'expression élevée de RIP140 ou de LCoR a été identifiée comme un marqueur de mauvais pronostic suggérant un rôle clé de ces deux gènes dans cette malignité.Pour mieux cerner le rôle de RIP140 dans le CG, nous avons utilisé les lignées cellulaires MKN45 et MKN74 de cancer de l’estomac humain avec une surexpression ectopique du gène RIP140 ou au contraire avec une diminution de son expression. Nos résultats ont montré que l'expression de RIP140 est associée à un effet anti-prolifératif à travers une régulation positive de l'expression du gène p21WAF1/CIP1. Nous avons également démontré que RIP140 réduit la migration des cellules MKN45 et MKN74 et augmente l'expression du gène E-cadhérine au niveau transcriptionnel. D’une manière intéressante, nos résultats suggèrent aussi que RIP140 régule la voie de signalisation Hippo à travers l’activation de TEAD.Dans l'ensemble, ces résultats suggèrent que les gènes RIP140 et LCoR participent à la régulation de la tumorigenèse gastro-intestinale et que leurs niveaux d'expression ont une valeur pronostique dans ces cancers et pourraient servir de nouveaux biomarqueurs dans la caractérisation moléculaire de ces tumeurs. / Gastrointestinal cancers, particularly colorectal cancer (CRC) and gastric cancer (GC), are aggressive pathologies with a high mortality rate worldwide. These cancers are characterized by the deregulation of cellular signaling pathways such as the Wnt, Notch and Hippo pathways which play a very important role in gastrointestinal tumorigenesis. Moreover, it’s well established that the activity of the transcriptionnel factors involved in these nuclear signaling pathways is controlled by many transcriptionnel coregulators. This work focused on two transcriptional coregulators initially identified as partners of nuclear receptors, namely RIP140 and LCoR. The objective was to explore the expression of these two transcription factors in gastrointestinal cancers and their role in gastric cancers mainly through the dialogue with the Hippo signaling pathway.Immunohistochemical analysis of RIP140 and LCoR expression in colorectal and gastric cancers showed that the expression levels of these two transcriptional regulators are strongly correlated. In CRCs, their expression tends to decrease in tumor tissue compared to adjacent normal tissue, whereas in GCs, RIP140 and LCoR expression levels are significantly higher in the tumor as compared to normal stomach. Significant correlations were observed with clinicopathological parameters (TNM stage and tumor differentiation) as well as the expression levels of key proteins involved in tumor progression and invasion (E-cadherin and Cox-2). Survival analysis showed that CRC patients with LCoRlow/RIP140high tumors have a significant prolonged OS and DFS. In GC, high RIP140 or LCoR expression was identified as an independent marker of poor prognosis suggesting a key role in this malignancy.Further, we investigated the role of RIP140 in gastric cancer cell lines using human epithelial GC cell lines overexpressing or not RIP140. In both MKN45 and MKN74 cells we showed that RIP140 exerted an anti-proliferative effect through the induction of p21WAF1/CIP1 gene expression. We also demonstrated that RIP140 reduced GC cell migration and increased E-cadherin expression at the transcriptional level. Interestingly, our results also suggest that RIP140 regulates the Hippo signaling pathway through TEAD activation.In conclusion, our findings suggest that RIP140 and LCoR genes contribute to the regulation of gastrointestinal cancers and that their expression levels have a prognostic value in these pathologies. Moreover, both RIP140 and LCoR transcriptional coregulaters could serve as novel biomarkers in the molecular characterization of colorectal and gastric cancers.

Le cancer colorectal (CCR) représente la 2ème cause de mortalité par cancer dans les pays industrialisés. De nouveaux traitements permettant de bloquer l’évolution de la maladie sont nécessaires. Il est donc important de mieux connaitre les acteurs impliqués dans la cancérogenèse. Lors du développement du cancer, des gènes suppresseurs de tumeur sont inhibés et des oncogènes sont activés, perturbant ainsi l’équilibre des cellules et les transformant. Au cours de ma thèse, je me suis intéressée à deux gènes homéotiques qui possèdent des rôles opposés dans les CCR. Cdx2 exerce un rôle suppresseur de tumeur, alors que HoxB7 agit comme un oncogène. Mon travail de thèse a permis (i) de mettre en évidence une nouvelle fonction non-transcriptionnelle de Cdx2 : inhibiteur de la réparation des cassures de l'ADN spécifiquement dans le côlon, (ii) et de révéler que le niveau d'expression des gènes Cdx2 et Hoxb7 au sein de la tumeur peut avoir une importance pour le choix du traitement des CCR. / Colorectal cancer is the 2nd cause of mortality by cancer in industrialized countries. New treatments allowing to prevent the evolution of the disease are needed. It is important to better understand the actors implicated in carcinogenesis. During cancer development, tumor suppressor genes are inhibited and oncogenes are activated, thus disrupting the homeostasis of the tissue and transforming the cells. During my thesis, I have been interested in two genes having two opposite functions in CCR : Cdx2 is a tumor suppressor while Hoxb7 acts as an oncogene. My work allows to highlight (i) a new non-transcriptional function of Cdx2 : inhibitor of the reparation of DNA breaks specifically in the colon, (ii) and that the expression level of Cdx2 and Hoxb7 genes inside the tumor can have an importance in the choice of the CCR treatment.

OBJETIVO: Determinar o impacto de fatores prognósticos na sobrevida de pacientes com metástases hepáticas ressecadas e originadas de câncer colorretal. CASUISTICA E MÉTODOS: Foram analisados os prontuários de 28 pacientes submetidos a ressecção hepática de metástases de câncer colorretal de Abril /1992 a Setembro /2001. Foram realizadas 38 ressecções (8 pacientes com mais de uma ressecção no mesmo tempo cirúrgico e 2 pacientes submetidos a re-ressecções). Todos haviam sido submetidos previamente à ressecção do tumor primário. Utilizou-se um protocolo de rastreamento de metástases hepáticas que incluiu revisões clinicas trimestrais, ecografia abdominal e dosagem de CEA até completarem-se 5 anos de seguimento e, após, semestralmente. Os fatores prognósticos estudados foram: estágio do tumor primário, tamanho das metástases > 5cm, intervalo entre ressecção do tumor primário e surgimento da metástase <1 ano, CEA>100ng/ml, margens cirúrgicas <1cm e doença metastática extra-hepática. O estudo foi retrospectivo e a análise estatística foi feita através da curva de Kaplan-Meier, do log rank e da regressão de Cox. RESULTADOS: A morbidade foi 39,3% e a mortalidade operatória foi 3,6%.A sobrevida em 5 anos foi de 35%. Os fatores prognósticos independentes adversos foram: intervalo <1 ano entre ressecção do tumor primário e surgimento da metástase (p=0,047 e RR 11,56) e doença metastática extra-hepática (p=0,004 e RR=57,28). CONCLUSÕES: A ressecção hepática de metástases de câncer colorretal é um procedimento seguro com sobrevida em 5 anos acima dos 30%. Foram fatores prognósticos independentes adversos: doença metastática extra-hepática e intervalo<1ano entre ressecção do tumor primário e surgimento da metástase. / Prognostic factors following liver resection for hepatic metastases from colorectal cancer. BACKGROUND: To determine the impact of prognostic factors on survival of patients with metastases from colorectal cancer that underwent liver resection. METHODS: The records of 28 patients that underwent liver resection for metastases from colorectal cancer between April /1992 and September/2001 were retrospectively analized. Thirty-eight resections were performed (more than one resection in eight patients and two patients underwent re-resections). The primary tumor was resected in all the patients. A screening protocol for liver metastases including clinical examinations every three months, abdominal ultrassonography and CEA level until five years of follow-up and after every six months, was applied. The prognostic factors analized regarding the impact on survival were: Dukes C stage of primary tumor, size of metastasis > 5cm, a disease-free interval from primary tumor to metastasis < 1 year, CEA level > 100ng/ml, resection margins < 1cm and extrahepatic disease. The Kaplan-Meier curves, log rank and Cox regression were used for the statistical analysis. RESULTS: Perioperative morbidity and mortality were 39,3% and 3,6% respectively. The 5-year survival rate was 35%. The independent prognostic factors were: disease-free interval from primary tumor to metastasis < 1year (p=0,047; RR=11,56) and extrahepatic metastatic disease (p=0,004; RR=57,28). CONCLUSIONS: The liver resection for metastases from colorectal cancer is a safe procedure with more than 30% 5-year survival .Disease- free interval from primary tumor to metastasis < 1year and extrahepatic disease were independent prognostic factors.

Bakgrund: Aktuell forskning lyfter kostens betydelse för tillfrisknande vid kolorektal cancersjukdom och föreslår kostbehandling som ett kompletterande behandlingsalternativ. Trots detta finns osäkerhet hos både patienter och sjuksköterskor om egenvårdsråd gällande kost vid utskrivning från kirurgisk vårdavdelning. Syfte: Syftet var att, från ett sjuksköterskeperspektiv, beskriva vilka egenvårdsråd om kost patienter som behandlas för kolorektal cancersjukdom efterfrågar och får inför utskrivning från kirurgisk vårdavdelning. Ett annat syfte var att beskriva vilken kunskap sjuksköterskor har för att ge egenvårdsråd om kost. Metodbeskrivning: En deskriptiv kvalitativ intervjustudie med semistrukturerade intervjuer med sjuksköterskor (n=11) på kirurgisk vårdavdelning genomfördes. Konventionell innehållsanalys användes vid dataanalys. Huvudresultat: En vanligt förekommande fråga från patienter med kolorektal cancersjukdom var om något i kosten bör uteslutas relaterat till diagnos. Patienterna rekommenderades att återgå till normal kosthållning och uppmanades att anpassa intaget efter tarmfunktion. Sjuksköterskornas rekommendationer baserades ofta på vilka frågor patienterna själva ställde. Gällande sjuksköterskors kunskap om egenvårdsråd om kost beskriver sjuksköterskorna ett ökat kunskapsbehov. Sjuksköterskorna hänvisade till andra professioner vid kostrådgivning samt en avsaknad av rutin för kostrådgivning framkom. Slutsats: Vaga och generella egenvårdsråd om kost till patienter med kolorektal cancersjukdom har identifierats. Sjuksköterskor tenderar att lämna över ansvar om kostråd till andra professioner och rutinerna för hur egenvårdsråd om kost skall ges är oklara, vilket bidrar till att en evidensbaserad kirurgisk omvårdnad inte uppnås. Ett angeläget behov finns således för rutinutveckling och förbättrad kunskap i ämnet hos sjuksköterskor, för att säkerställa att patienter får ta del av viktig information för tillfrisknande och att förutsättningar för en god egenvård skapas. / Background: The importance of a nutritional diet in the recovery of patients with colorectal cancer disease is acknowledged in current research, with nutritional therapies recommended as a complementary treatment option. Despite this, it has been recognized that many nurses and patients experiencing uncertainty regarding evidence based dietary advice at the point of discharge from the surgical departments. Aim: Firstly, it sets out to describe, from a nurse perspective, what dietary advice patients with colorectal cancer asks for and receives at the point of discharge from the surgical care department. Secondly it aims to describe what knowledge nurses possess in providing dietary advice. Method: A descriptive qualitative interview study was conducted, involving semi-structured interviews with nurses within a surgical care department (n=11). Conventional content analysis was used in data analysis. Results: A common question from patients was if something should be excluded in their diet following their diagnosis. Patients were advised to return to their normal diets and were encouraged to adjust their food intake in accordance with their intestinal function. Recommendations given by nurses were often led by the questions asked by the patients themselves. The nurses described a need for increased knowledge and education to sufficiently advice patients in the effective dietary self-management following discharge. Nurses referred to other professions in dietary advice and a lack of routine for dietary advice emerged. Conclusion: Discharge dietary self-management advise for patients with colorectal cancer disease has been identified as vague and impersonal. It has been suggested that nurses are prone to delegate the responsibility for dietary advices to other professions. This is further complicated by no current clear guidance on what constitutes effective dietary self-management, thus hindering evidence-based practice. Subsequently, there is an urgent need for further developed protocols and improved knowledge among nurses to ensure optimal dietary self-management for patients with a view to increase effective recovery and general wellbeing.

LRP1 (low-density lipoprotein receptor–related protein 1), un récepteur endocytaire multifonctionnel, a récemment été identifié comme pivot d’un réseau de biomarqueurs pour la prédiction pronostique de plusieurs types de cancers. Son rôle dans le cancer du côlon n'a pas été caractérisé. Notre travail porte sur l’étude de la relation entre expression de LRP1 et cancer du côlon.L'expression de l'ARNm LRP1 a été déterminée dans des échantillons d'adénocarcinome et de muqueuses coliques appariées, ainsi que dans les cellules stromales et tumorales obtenues après microdissection laser. Les associations clinicopathologiques et moléculaires ont été étudiées par immunohistochimie dans une série de cancer colique (n = 307). La présence de méthylation ou mutation du gène LRP1 et l'expression de miR-205 ont été évaluées et comparées aux niveaux d'expression de LRP1.L’ARNm de LRP1 est sous exprimé dans les cellules d'adénocarcinome colique par rapport à la muqueuse colique par rapport aux cellules stromales. La faible expression immunohistochimique de LRP1 dans les adénocarcinomes était associée à un âge plus élevé, à localisation droite, une perte d'expression de CDX2, une expression d'Annexine A10, un statut CIMP-H, MSI-H et BRAFV600E muté. Cette faible expression était associée à un mauvais pronostic, en particulier chez les patients de stade IV. Les mutations du gène LRP1 entrainaient une sous-expression de LRP1. L’expression était peu modifiée par miR-205. Le promoteur de LRP1 n'était jamais méthylé.La perte d'expression de LRP1 est associée à un profil clinico-pathologique et moléculaire particulier et à un un mauvais pronostic dans les cancers du côlon. / LRP1 (low-density lipoprotein receptor–related protein 1), a multifunctional endocytic receptor, has recently been identified as a hub in a biomarker network for multi-cancer clinical outcome prediction. Its role in côlon cancer has not been characterized. Here, we investigate the relationship between LRP1 and colon cancer.LRP1 mRNA expression was determined in colon adenocarcinoma and paired colon mucosa samples, and in stromal and tumoral cells obtained after laser capture microdissection. The clinical potential was further investigated by immunohistochemistry in a population-based colon cancer series (n = 307). LRP1 methylation, mutation and miR-205 expression were evaluated and compared to LRP1 expression levels.LRP1 mRNA levels are significantly decreased in colon adenocarcinoma cells compared to colon mucosa and stromal cells. Low LRP1 immunohistochemical expression in adenocarcinomas was associated with higher age, right-sided tumor, loss of CDX2 expression, Annexin A10 expression, CIMP-H, MSI-H and BRAFV600E mutation. Low LRP1 expression correlates with poor clinical outcome, especially in stage IV patients. LRP1 expression was downregulated by LRP1 mutation. LRP1 expression was slightly modified by miR-205 expression. LRP1 promoter was never methylated.Loss of LRP1 expression is associated with peculiar clinocopathological and molecular characteristics and with worse colon cancer outcomes.

L'épithélium intestinal est caractérisé par un renouvellement et une différenciation continus dépendant des cellules souches somatiques situées au fond des cryptes. Le renouvellement rapide est assuré par plusieurs réseaux de voies signalisation dont la dérégulation peut être à l'origine de l'initiation et/ou de la progression tumorale. Mon laboratoire d'accueil a décrit l'implication des hormones thyroïdiennes et de leur récepteur nucléaire TRa1 dans le contrôle de l'homéostasie de l'épithélium intestinal via la régulation de la voie Wnt/b-caténine d'une part et l'implication de TRa1 dans l'induction de tumeurs intestinales grâce à des souris surexprimant TRa1 d'autre part. De plus, dans un contexte APC muté, l'expression transgénique de TRa1 accélère la progression tumorale et favorise la dissémination métastatique. Des analyses transcriptomiques mettent en évidence une forte activation de la voie Wnt par TRa1. Ces résultats ont été confirmés chez l'homme en étudiant la régulation de la voie Wnt par TRa1 dans des carcinomes colorectaux (CRC). Nous avons confirmé la surexpression de TRa1 dans les tumeurs humaines et validé son impact sur la voie Wnt tant dans les tumeurs humaines que dans des lignées cellulaires et sur leur agressivité. L'ensemble des données montre une forte implication de TRa1 dans la tumorigenèse chez la souris et chez l'homme et ouvrent des portes pour des recherches visant TRa1 comme cible de traitement thérapeutique contre le cancer / The intestinal epithelium is characterized by constant renewal and differentiation due to the presence of stem cells located at the bottom of the crypts. This permanent renewal depends on the crosstalk between several signaling pathways whose alteration can lead to tumor initiation and progression. Our team demonstrated the implication of the thyroid hormones and their nuclear receptor TRa1 in the control of the intestinal epithelium homeostasis through the regulation of the Wnt pathway. Moreover, the overexpression of TRa1 in the intestinal epithelium of mice is sufficient to promote tumor initiation, and in an APC loss of function context, it accelerates tumor progression highlighting its oncogenic potential. Through gene expression profiling, we highlighted an activation of the Wnt pathway activity by TRa1 during tumor progression. We next confirm these results in human patient samples by demonstrating that high TRa1 expression in tumors invariably is associated with an increased Wnt pathway activity. In addition, in CRC cell lines, TRa1-associated WNT pathway activation enhances their aggressiveness. Altogether these results showed the implication of TRa1 in intestinal carcinogenesis and open avenues for new therapeutic treatment against TRa1 targeting TRa1